It’s now Wednesday afternoon and with no internet at our hotel or the hospital communication has been difficult. The state minister of health who I met with this morning has kindly let me use an office in the ministry this afternoon…it not only has wifi but a fan, which is great relief in the 45deg heat!

We arrived in Wau quite early on Monday morning having been ably assisted with transport and flights and access to the VIP lounge in Juba by Dr Kediende from the MOH who has looked after us well. Unfortunately the ministry can no longer support our internal flights so all the funding is down to the link now.

We had out usual tour of the hospital and Sally and I, having been here several times were very encouraged by the improvements, not only in the buildings but in the number of medical officers and the improved skills of the student nurses.

For the last couple of days Sally and Hilary have been concentrating on maternity and starting to set up a small high dependence area there. Along with James they were in theatre this morning for a Caesarian section and the baby proved difficulty to resuscitate. Early this afternoon the baby deteriorated and despite the best attempts of our team he sadly died. Sadly this is the third baby who has died in maternity since our arrival. James has been working with the new anaesthetists mostly in the lovely new maternity theatre.

This morning I met with the state minister of health Dr Isaac Cleto and we had a very useful discussion. There will soon be a big investment in the hospital which will be carried out by IMC so we will see more changes.

Our teaching programme at Sr Gracy’s Mary Help Nursing school has started with James and I teaching resuscitation, and the midwives obstetric emergencies. We received an amazing welcome from the students who sang a welcome to us and Sr Gracy who made us cake! The skeleton we took them caused great hilarity. We went with Sr. Gracy to see the progress on the new hospital she’s building out of town.

It’s great to be back in Wau despite the extreme heat which is exhausting but we have had lots of very warm welcomes from old friends and new.

The team had great assistance from South Sudanese friends at Juba, and were able to fly to Wau this morning, Monday 23rd February – with all their kit and personal luggage. More details to follow when they obtain access to the internet.

We’re getting into our routine now, arriving at the hospital at 8:30 and going to our various departments in the morning. One highlight of the day was meeting again Dr Isaac Cleto the Minister of Health for Western Bahr El Ghazal . We were pleased to hear that he had followed our previous advice of building the new maternity unit on the Wau hospital site. Already there is a new purpose built antenatal clinic.

Hilary and Bruce met with the chief health trade unit representative and discussed the universal problems of pay and conditions. Prem, Hilary and Bruce had a warm welcome at the Episcopal church where they went to inspect the potential future site of permanent accommodation for the Link.

As usual we went to the two nursing colleges to give further teaching in the afternoon. The midwifery students will never forget the McRoberts manoeuvre now, as demonstrated by a strange English woman (Hilary) with legs akimbo.

Unfortunately Bruce only managed to fix a plug socket today but we hope our Mr Fix it will have a more productive time again tomorrow.

We arrived at the hospital bright and early, enthusiastic to start teaching and re-establishing relationships with doctors, nurses and midwives we have met on previous trips. It was a day of ups and downs. Bruce did a great job sorting out the store room and our kit bags. We found the ECG machine and the monitor for the HDU. We delivered supplies to theatres, paediatrics , ophthalmology, the HIV clinic and outpatients. Bruce mended the autoclave in ophthalmology, his next job is the suction machine. Sally disappeared off to the antenatal clinic and labour ward where she had a productive morning teaching students, and her prompt decisive action ensured a woman with a severe intra-partum haemorrhage got to theatre in time to save her baby. Although Prem feels she should get some of the credit for dashing round Wau looking for the obstetrician with our trusty driver, Justin.

Alli and Antoinette joined the paediatric ward round and were impressed by James the medical officer, who spent time teaching the junior doctors and nurses and discussing interesting clinical cases with Antoinette. After the ward round and outpatients Alli and Antoinette found the energy to each do a teaching session on the ward. Alli gave a very interesting talk on the development of paediatric nursing in the UK and Antoinette taught on the importance of vital signs and recognition of the deteriorating child. Meanwhile Hilary was everywhere saying hello and delivering kit. Prem visited the medical wards but there were not many patients, doctors or nurses around. Bruce, Alli and Hilary went off to teach at Sister Gracie’s and Prem, Sally and Antoinette went to CHTI. The students really enjoyed their interactive session with Sally learning about IUCDs, apparently vasectomy is not very common in South Sudan. Prem tried her best to explain the uses and science of MRI and CT scanning. Bruce and Alli taught ETAT triage and ABCDE to Sister Gracie’s students. Antoinette took 30 students through infant BLS. So all in all a busy and productive day. You would have thought we deserved a beer at the end of it all but we are not sure our hosts approve, although Prem swears it is medicinal and keeps the bacteria at bay. Please check out Poole Africa Link Facebook for more photographs.

– the hospital water suppy has arrived

– a lady in the eye clinic receives a pair of glasses from Poole Africa Link

Sunday our day of rest, however we were up early to attend the English service at the ECS (Episcopal Church of Sudan) Cathedral. Hilary delivered a message from the Bishop of Salisbury to the congregation of Wau. The whole team were invited to introduce themselves to the congregation for which we received warm applause.

We returned to Dorcas to work on our teaching for tomorrow. Later Justin our driver picked us up to take us for lunch with Dr Alex Bakiet (Director General of Wau Hospital) and the fistula team who were taking a well-earned day off after performing 35 operations in 5 days. Fistulas are caused by obstructed labour; they are rare in the western world but still common in South Sudan. These women are ostracised from society but with surgery get a second chance for a happy family life. The team consisted of 2 surgeons, a midwife, a theatre nurse and an anaesthetist from Kenya and Uganda. We had a traditional meal of barbequed goat and chapatis; all eating with our hands from a large platter between us. Bruce tucked in with gusto but the rest of us struggled a little with digesting the goat. We were pleased to see the other visitors also struggling with the heat.

We returned to Dorcas later in the afternoon in time for a leisurely stroll through the local village to take a few pictures and meet some local children enticed by balloons and stickers. This evening Hilary, Bruce and Sally taught some of the children to play Frisbee. Now it is time for a warm tusker….electricity is a bit erratic and the fridge doesn’t work!

Team all up early and raring to go. Our lift turned up on time (thanks Justin), and we arrived at Wau hospital for 8am.

We all started by setting up teaching equipment in the resource room in preparation for “Emergency Triage and Assessment “covering all age groups.

Sally taught neonatal resus, Bruce presented the ETAT emergency triage system, Prem presented emergency assessment and treatment of adults and Antoinette presented assessment of paediatric emergencies. The students then split into two groups for paediatric scenarios facilitated by Allison and Antoinette and adult scenarios facilitated by Bruce and Prem. Attendees included student nurses and midwives, one of the tutors from CHTI and Liz McCall a VSO nurse seconded to Wau Teaching Hospital for 2 years.

Throughout the morning the Hospital was in a state of high alert for the much anticipated visit of the Minister of Health for South Sudan and his entourage. The group including the Under Secretary and the State Minister for Health were shown around the hospital by Dr Alex Bakiet (Director General of Wau Hospital) and were followed around by a TV crew. We all met the Minister for Health, and had our picture taken with the visiting dignitaries. Hilary spoke with the Minister of Health and was very encouraged by his enthusiasm for the link with Poole Hospital. He has requested to meet with us on our return to Juba.